Intended for healthcare professionals


Preventing osteoporosis, falls, and fractures among elderly people

BMJ 1999; 318 doi: (Published 19 June 1999) Cite this as: BMJ 1999;318:1695

Few exercise programmes studied have prevented falls

  1. Gene Feder, Senior lecturer (,
  2. Yvonne Carter, Professor,
  3. Sheila Donovan, Facilitator,
  4. Colin Cryer, Statistician
  1. Department of General Practice and Primary Care, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS
  2. South East Institute of Public Health, King's College London, Tunbridge Wells, Kent TN3 0XT
  3. Austin and Repatriation Medical Centre, University of Melbourne, Melbourne, Australia
  4. Accident and Trauma Research Centre, UKK Institute, PO Box 30, FIN-33501 Tampere, Finland

    EDITOR—Kannus promotes physical activity for the prevention of injurious falls among elderly people.1 He acknowledges the uncertainty that surrounds the effectiveness of specific exercise programmes tested as interventions in randomised controlledtrials. This is in contrast to the epidemiological evidence from longitudinal cohort or case-control studies. We agree with him that regular physical activity outside formal exercise programmes islikely to be beneficial to both younger and older people.

    In developing evidence based guidelines for the prevention of falls in older people we found good evidence that exercise programmes for unselected older people living in the community do not prevent falls,2 with the possible exception of balance training (tai chi).3 Two trials found that selected older people (those aged over 804 or with mild deficits in strength and balance5) benefit from individually tailored exercise programmes administered by qualified professionals. Our guidelines recommend that the implementation of exercise programmes for unselected older people should not be a priority.

    By contrast, multifaceted intervention programmes, including the identification and treatment of postural hypotension, review of drug treatment, modification of the home …

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